Anne H. Rowley

Patterns of Kawasaki syndrome presentation

Kawasaki syndrome (KS) is a systemic disorder of unknown etiology that can lead to coronary artery aneurysm and thrombosis in a significant number of children. It is defined by a number of clinical guidelines set by the Centers for Disease Control (Rauch, A.M., Hurwitz, E.S. (1985) Centers for Disease Control (CDC). Case Definition for Kawasaki syndrome. Pediatr. Infect. Dis. 4, 702-703). Many of the symptoms of this illness may lead the patient to the otolaryngologist. These criteria include injected or fissured lips, injected pharynx, strawberry tongue and cervical lymphadenopathy. When administered in the first 10 days of the illness, gamma globulin has been demonstrated to reduce the prevalence of coronary artery abnormalities (Newburger, J.W., Takahashi, M., Burns, J.C. et al. (1986) Treatment of Kawasaki syndrome with intravenous gamma globulin. N. Engl. J. Med. 315, 341-347). Unfortunately, when a diagnosis of KS is not considered or if a patient presents with unusual symptoms that are not consistent with the CDC guidelines, the diagnosis and treatment of KS can be delayed or even missed. We present a series of patients with KS to illustrate its patterns of presentation.

Timely diagnosis of congenital infections

The acronym TORCH has served to increase awareness of congenital infections; however, this collective term suggests that the clinical manifestations of congenital infections are not distinguishable by pathogen. Although some clinical features may be common to several of these infections, a congenital infection caused by one pathogen generally can be distinguished from infection caused by another pathogen on a clinical basis. Pediatricians need to be aware of the prominent features of each congenital infection rather than to consider them collectively. This article focuses on the prominent features of the more common congenital infections, suggests a specific diagnostic approach, and reviews the available therapeutic strategies.

Pediatric tuberculosis: An update

The incidence of tuberculous infection and disease in children has risen significantly over the last decade. The management of TB has become more complicated by the changing epidemiology of this disease and the emergence of resistant MTB. Many new recommendations have recently been made to address these issues. It is crucial that pediatricians become familiar with this disease again and have a good working knowledge of pediatric TB.